Provider Demographics
NPI:1306869516
Name:GARNET L PATTERSON DDS, LTD
Entity type:Organization
Organization Name:GARNET L PATTERSON DDS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARNET
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-479-5865
Mailing Address - Street 1:19721 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1307
Mailing Address - Country:US
Mailing Address - Phone:708-479-5865
Mailing Address - Fax:708-479-4630
Practice Address - Street 1:19721 WOLF RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1307
Practice Address - Country:US
Practice Address - Phone:708-479-5865
Practice Address - Fax:708-479-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003276Medicaid
IL1003276Medicaid
ILU33592Medicare UPIN